California was the first state to enact a paid family leave entitlement in 2002, providing eligible workers up to six weeks of paid leave in a twelve-month period at 55 percent of the worker’s normal earnings up to a maximum benefit. Building on prior literature that has linked parental leave to child health, including rates of infant mortality, Jessica E. Pac, Ann P. Bartel, and Jane Waldfogel of Columbia University, and Christopher J. Ruhm of the University of Virginia evaluated the effect of California’s paid family leave policy on breastfeeding in this National Bureau of Economic Research Working Paper.


Using a sample of over 270,000 mother-child pairs representing births between 2000 and 2012, the research team used data from the National Immunization Survey to explore patterns of breastfeeding initiation and duration. Their results suggest:

  • Paid family leave significantly increases overall breastfeeding duration by nearly 18 days (from a base of 221 days) and breastfeeding for at least six months by 4.9 percentage points (from a previous average of 53 percent).
  • There was little effect on the probability of initiating breastfeeding.
  • There were substantially larger effects for historically disadvantaged groups of women for both breastfeeding duration measures.

Implications for Policy and Practice

Breastfeeding has long been considered the most beneficial source of nutrition for infants, with breastfeeding being linked to strengthened immunity, reduced likelihood of sudden infant death syndrome (SIDS), and long-term risk reductions for obesity, diabetes, and asthma. Over the last few decades, U.S. rates of breastfeeding have improved overall, but low-income mothers have actually become less likely to breastfeed their children. A leading reason for mothers stopping breastfeeding is the need to return to work soon after birth.

The U.S. does not offer paid maternity or parental leave as a statutory entitlement. Although up to 12 weeks of job-protected unpaid leave has been available since the enactment of the Family Medical Leave Act of 1993, unpaid leave is often out of reach for disadvantaged families who rely on the steady source of income to make ends meet. The findings here suggest that paid family leave may reduce disparities in breastfeeding, and that providing paid family leave to families in states without current mandates may have positive impacts on breastfeeding behaviors. In the absence of such policies, national and state public health campaigns to increase breastfeeding may have limited impact. This is particularly true for lower income mothers who are less likely to receive employer-provided paid leave.